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Preoperative fall history is associated with increased postoperative complications at 2 years after primary total
Hahn Kang1, Muhammad Hamza Ilyas1, Isaiah A Freeman1
1Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Purpose:
Falls are common in patients with advanced knee osteoarthritis undergoing total knee arthroplasty (TKA), with the reported preoperative prevalence ranging from 23% to 63%, and may reflect frailty and functional impairment that could influence postoperative outcomes. However, the potential association between a documented preoperative fall history and postoperative outcomes after primary TKA remains unclear. This study aimed to compare 90-day, 1-year and 2-year TKA outcomes in propensity-matched patients aged ≥65 years with and without a documented preoperative fall history.
Methods:
A federated research health network was queried to identify patients aged ≥65 years who underwent primary TKA with at least 2 years of follow-up. Preoperative fall history was defined by International Classification of Diseases codes within 1 year before TKA. We performed 1:1 nearest-neighbour propensity score matching on age, sex, body mass index, medications and modified frailty index variables yielding 7000 patients per group. Continuous variables were compared using independent t-tests, and categorical variables were compared using chi-square or Fisher exact tests. The 90-day and 1- and 2-year outcomes were evaluated.
Results:
Compared with matched controls, patients with preoperative falls had higher 90-day postoperative falls (6.4% vs. 1.7%), emergency department visits (19.2% vs. 12.1%), readmissions (11.9% vs. 8.7%), surgical site infections (0.8% vs. 0.4%) and medical complications (all p < 0.05). The falls cohort had higher postoperative falls (1-year: 9.5% vs. 4.2%; 2-year: 15.3% vs. 8.4%), revision (1-year: 2.1% vs. 1.2%; 2-year: 2.8% vs. 1.8%), periprosthetic joint infection (1-year: 2.3% vs. 1.4%; 2-year: 2.8% vs. 1.7%), periprosthetic fracture (1-year: 0.7% vs. 0.4%; 2-year: 1.0% vs. 0.6%) and 2-year mortality (3.3% vs. 2.3%) (all p ≤ 0.01).
Conclusion:
A history of one or more falls within the year preceding surgery was associated with increased 90-day complications and higher 1- and 2-year risks of adverse surgical outcomes and mortality. These findings support incorporating fall history into routine preoperative risk stratification and targeted perioperative optimisation and follow-up strategies for patients at increased risk.
Level Of Evidence:
Level III.
